One in four children in school classrooms, pediatrician offices, houses of worship, and communities more broadly is managing something potentially very difficult at home…but they often feel invisible and unsupported.
It’s not that these youth are intentionally ignored or their needs are deliberately overlooked by healthcare or educational systems. Rather, these young people simply are not recognized and their experience is not named. In fact, there isn’t even a generally agreed-upon name for them in the USA, either in everyday language or research.
Yet, living with this family issue increases the risk for a wide range of short- and long-term difficulties, such as mental and physical health problems, developmental delays, challenges with peers, and school difficulties.
So, who are these kids?
They are children of parents living with a mental illness.
Recent research
Research from the Centers for Disease Control and Prevention (CDC) studied Adverse Childhood Experiences (ACES) among high school youth; they found that over 1/4 of youth had a parent/guardian with severe mental health problems or who was suicidal. That’s a sizable percentage of kids, and is a much higher prevalence than the number of youth dealing with other family challenges such as parental cancer, incarceration, or death.
Other recent research about children whose parents have psychiatric problems reveals sobering findings about the risk of these offspring developing mental health problems themselves. Specifically, the chance that an individual whose parent manages mental illness will develop some form of mental illness is 55% with parental bipolar disorder, 51% with parental depressive disorder, and 17% with parental psychosis…rates much higher than the general population.
The Children With No Name
In other countries, there are accepted terms for these young people, such as “young carers” in Europe and COPMI (Children of Parents with a Mental Illness) in Australia. These terms are meaningful as they identify this group of people in research and common parlance, and help to legitimize their experience.
In the USA, while there are terms for offspring of parents with substance use problems, namely children of addiction (COA), and children of deaf adults/parents (CODA), there is no commonly accepted term in the realm of parental mental illness.
Further, these youth are rarely portrayed in the media, which can contribute to the public’s lack of awareness of their experience. Although a couple mainstream movies 20 years ago (i.e., Canvas, 2006 and About a Boy, 2002), did portray two young boys dealing with mothers who had significant psychiatric problems, such depiction is quite rare.
The Children With No Formal Services in the USA
Along with not having a name, there are very few formal supports for children of parents managing a mental illness in the USA. There are no organizations in our country specifically for these youth—which is in contrast to countries such as the United Kingdom, Canada, Iceland, and Australia that have formal programs. Large mental health organizations (e.g., Mental Health America, National Alliance on Mental Illness) have not explicitly recognized or focused on these at-risk youth, and, to the best of my knowledge, there are no commonly-used curricula, resources, or programs for them. This is in sharp contrast to the support we as a country provide children managing other familial challenges, such as parental cancer, dementia, and incarceration. A simple online search quickly reveals inviting resources, camps, support groups and more for these youth.
Closely related but not synonymous with parental mental illness is the domain of parental addiction. For years there has been recognition of offspring of parents managing addiction, such as support groups (e.g., Alateen), organizations (e.g., National Association for Children of Addiction), children’s programs in some addiction treatment centers (e.g., Hazelden Betty Ford’s children’s programs), and many books/resources. Although these children can also be unseen by overwhelmed families, they have been named and recognized for many years.
These Children Have Legal Rights in Some Countries
in some countries, children of parents managing mental illness have formal legal rights. For example, in Norway, legislative policies require healthcare personnel to provide minor children with information and supports in the context of parental mental illness. Staff must register the children in the health record, help identify the children’s needs, educate parents, and connect families with other services. Similarly, new legislation in the United Kingdom (as part of their Mental Health Act Code of Practice) requires specific actions when a parent is involuntarily admitted to the psychiatric unit. Specifically, staff must identify the parent’s children, provide the youth with information and support, and provide referrals if needed. Laws such as these in Norway and the United Kingdom can also be useful in leveraging funding for supportive services for these youth and families.
The Potential Consequences
So, without a name, an organization, easily accessible supports tailored to their needs, and formal rights in our country, where does this leave these kids? They are frequently invisible…often feeling alone, confused, angry, scared, sad, and powerless.
Without external supports, the task of supporting these kids often falls to parents and other family members. However, parents often have minimal guidance on what to say and how to support their children. Due to the complexity of mental illness and other family demands, sometimes children are told nothing…which can result in kids coming up with inaccurate and often scary explanations, such as blaming themselves for their parent’s illness.
And, from a healthcare perspective, there are many missed opportunities to offer prevention and early intervention services, as well as more formal treatment when appropriate.
Opportunities
So, where to start? There are excellent organizations around the world who have been seeing and supporting these children for decades, such as the Our Time charity in the United Kingdom that provides KidsTime workshops for parents with mental health problems and their children. Australia’s Children of Parents with a Mental Illness (COPMI) is a nation-wide program that offers education, online resources, and supports for these children and families. Canada’s Reconnect Health Systems has regular drop-in sessions for kids 7-12 whose parent has a mental illness named FAMEKids.
But, before we can start building programs in the USA, we need to start at the beginning…identification.
Are we ready to start seeing these young people? It’s up to all of us. Stay tuned for my next blog about how we can do so.
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